Term
| What associated pulmonary symptoms should be assessed? |
|
Definition
-shortness of breath (caused by how much work or effort?)
-nocturnal orthopnea (how many pillows used?)
-difficulty sleeping
-sleeping position
-cough (productive?)
-wheezing
-chest tightness
-congestion
-fever
-chills
-night sweats |
|
|
Term
| What respiratory and related past medical history should be assessed? |
|
Definition
-allergies
-emphysema
-bronchitis
-asthma
-pneumonia
-recent/recurrent URI
-TB- last CXR and PPD
-malignancy
-heart failure
-GERD
-allergies
-family history of above conditions |
|
|
Term
| What relevant habits should be assessed? |
|
Definition
-smoking
-toxins
-travel
-pets
-medications/drugs |
|
|
Term
| What other systems are often assessed when a respiratory complaint presents? |
|
Definition
-cardiac
-musculoskeletal
-neurological
-URI, HEENT |
|
|
Term
| What are some considerations for the setting of the respiratory exam? |
|
Definition
-patient disrobed from the waist up
-good lighting |
|
|
Term
| What are causes of intercostal inspiratory retractions or expiratory bulges? |
|
Definition
-asthma
-tumor
-tracheal/bronchial occlusion
-COPD |
|
|
Term
| What are causes of an asymmetric chest configuration? |
|
Definition
|
|
Term
| What are causes of an increase in AP diameter? |
|
Definition
|
|
Term
| How is respiratory excursion assessed? |
|
Definition
-place hands on posterior rib cage with thumbs at 10th rib/anterior rib cage with thumbs at xiphoid process, pinching/puckering skin between thumbs
-ask patient to take a deep breath
-observe a/symmetrical motion of hands |
|
|
Term
| What are causes of asymmetrical respiratory excursion? |
|
Definition
-atelectasis
-pneumothorax
-fibrosis |
|
|
Term
| What are causes of decreased respiratory excursion? |
|
Definition
|
|
Term
| What is the purpose of assessing tactile fremitus? |
|
Definition
-rough estimate of lung condition
-guide further assessment |
|
|
Term
| What are causes of increased tactile fremitus? |
|
Definition
solidity or consolidation:
-pneumonia
-tumor
-pulmonary fibrosis |
|
|
Term
| What are causes of decreased tactile fremitus? |
|
Definition
abnormal fluid- or air-filled spaces:
-pleural effusion
-pneumothorax
-emphysema |
|
|
Term
| What is a cause of absence of tactile fremitus? |
|
Definition
| -extensive bronchial obstruction |
|
|
Term
| What is the purpose of percussing lung fields? |
|
Definition
-estimate relative amounts of air, fluid, and solid matter
-identify margins of organs |
|
|
Term
|
Definition
-area superior to the clavicles that connects the anterior and posterior aspects of the chest
-1st area percussed |
|
|
Term
| What are causes of hyperresonance in percussion? |
|
Definition
air trapping:
-COPD
-superior to atelectasis
-superior to pleural effusion |
|
|
Term
| What are causes of dullness in percussion? |
|
Definition
-site of atelectasis
-site of pleural effusion
-tumors
-consolidation
-pneumonia |
|
|
Term
|
Definition
-over the trachea
-loud
-inspiratory < expiratory |
|
|
Term
| bronchiovesicular lung sounds |
|
Definition
-over bronchi
-medium intensity
-inspiratory = expiratory |
|
|
Term
| What are causes of increased breath sounds? |
|
Definition
consoidation:
-tumor
-pneumonia
-atelectasis |
|
|
Term
| What are causes of decreased breath sounds? |
|
Definition
-bronchial obstruction
-shallow breathing |
|
|
Term
| What aspects of adventitious sounds should be described? |
|
Definition
-pitch
-amplitude
-quality
-early/late in respiratory cycle |
|
|
Term
| What should you ask the patient to do if crackles and wheezes are heard? |
|
Definition
| -cough, to mobilize bronchial secretions |
|
|
Term
| What is the significance of low-pitched, coarse, early inspiratory crackles/rales? |
|
Definition
|
|
Term
| What is the significance of medium-pitched, mid-inspiration crackles/rales? |
|
Definition
in smaller bronchial branches:
-bronchiectasis |
|
|
Term
| What is the significance of high-pitched, fine, late inspiration crackles/rales? |
|
Definition
in bronchioles/alveoli:
-emphysema
-atelectasis
-pneumonia
-CHF
-pulmonary fibrosis |
|
|
Term
| What is the significance of low-pitched, early, deep wheezes/rhonchi? |
|
Definition
|
|
Term
| What is the significance of high-pitched, hissing wheezes/rhonchi? |
|
Definition
in smaller airways:
-asthma |
|
|
Term
| What is the significance of loud, grating, late inspiratory/early expiratory friction rub? |
|
Definition
inflamed pleura:
-pneumonia
-pleuritis
-malignancy |
|
|
Term
| Where is a pleural friction rub usually noted? |
|
Definition
| lower anterolateral lung fields |
|
|
Term
|
Definition
-increased volume in a lung field
-indicative of consolidation or effusion |
|
|
Term
| positive whispered pectoriloquy |
|
Definition
-increased clarity
-indicative of consolidation |
|
|
Term
|
Definition
-nasal quality in a lung field, "ee" heard as "ay"
-indicative of consolidation |
|
|
Term
| What are some diagnostic studies used to assess respiratory conditions? |
|
Definition
-spirometry
-ABGs
-pulse oximetry |
|
|
Term
| What are some imaging studies used to assess respiratory conditions? |
|
Definition
-plain films
-computed tomography (CT)
-magnetic resonance imaging (MRI)
-positron emissions tomography (PET) scans |
|
|
Term
| What is the distinction between acute and chronic cough? |
|
Definition
|
|
Term
| What are the s/s of postnasal discharge syndrome (PNDS)? |
|
Definition
symptoms:
-chronic cough
-sensation of drainage and need to clear throat
-hoarsenesss
-similar to allergic rhinitis, chronic sinusitis, URI
signs:
-throat clearing
-drainage on posterior pharynx
-hyperemia
-cobblestoning of posterior pharynx
-negative chest exam |
|
|
Term
| What are the s/s of asthma? |
|
Definition
symptoms (worsened with activity, exposure to allergens, viral infections):
-chest tightness
-nonproductive cough
-wheezing
-shortness of breath
signs:
-paroxysmal coughing with deep respiratory effort
-use of accessory muscles
-signs of atopy: allergic rhinitis, atopic dermatitis |
|
|
Term
| What are some diagnostic studies used for asthma? |
|
Definition
-FEV1 (diminished, improved with bronchodilators)
-chest films (WNL, unless air trapping)
-NOT peak flow meters- only for monitoring |
|
|
Term
| What are the 2 component problems of COPD? |
|
Definition
-chronic bronchitis
-emphysema |
|
|
Term
| What are the causes of COPD? |
|
Definition
-smoking
-alpha 1 antitrypsin deficiency |
|
|
Term
| What are the s/s of COPD? |
|
Definition
symptoms:
-chronic cough
-sputum production
-worse on exertion and progressive
signs:
-diminished lung sounds
-crackles
-barrel chest (AP > lateral diameter) |
|
|
Term
| What are signs of progressed COPD? |
|
Definition
-right heart failure
-abdominal distension
-liver tenderness
-edema |
|
|
Term
| Which diagnostic studies are used in COPD? |
|
Definition
-spirometry (decreased FEV1 to forced vital capacity)
-chest radiographs (lung hyperinflation, flattened diaphragm)
-qualitative serum, then quantitative, for alpha-1-antitrypsin deficiency |
|
|
Term
| What are s/s of pneumonia? |
|
Definition
symptoms:
-cough
-fever
-malaise
-shaking chills
-rigors
-chest discomfort
signs:
-tachycardia
-tachypnea
-fever
-uneven fremitus
-dull percussion
-bronchial breath sounds
-crackles
-bronchophony, egophony, whispered petoriloquy |
|
|
Term
| What are diagnostic studies for pneumonia? |
|
Definition
-chest film
-WBC count
-cultures and Gram stains (inpatient) |
|
|
Term
| What are s/s of acute bronchitis? |
|
Definition
symptoms:
-cough (initially productive; for several weeks after initial infection)
-fever
-malaise
-chest discomfort
-chills
-HA
signs:
-wheezes, crackles (change with cough effort) |
|
|
Term
| Which diagnostic studies are used in acute bronchitis? |
|
Definition
| only ones to r/o pneumonia and asthma, or monitor response to therapy |
|
|
Term
| How does GERD cause cough? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are causes of acquired bronchiectasis? |
|
Definition
-infections
-bronchial obstruction
-CF |
|
|
Term
| What are s/s of bronchiectasis? |
|
Definition
sypmtoms:
-chronic, productive cough
-mucopurulent sputum
-shortness of breath
-fatigue
-pleural pain
signs:
-hemoptysis
-wheezing
-crackles
-weight loss
-clubbing
-cyanosis |
|
|
Term
| What are diagnostic studies for bronchiectasis? |
|
Definition
-chest films: linear markings, atelectasis, pulmonary cysts
-CT scan
-sputum studies
-CBC: anemia, polycythemia, increased WBC |
|
|
Term
| What are risk factors for TB? |
|
Definition
-low SES
-impaired immune system
-crowded conditions |
|
|
Term
|
Definition
symptoms:
-malaise
-fevers
-cough (non-productive, then sputum)
-dyspnea
-night sweats
-hemoptysis
signs:
-weight loss |
|
|
Term
| What are diagnostic studies for TB? |
|
Definition
-chest films: hilar adenopathy, multilobular granulomas (especially of upper lungs, so a lordotic view is needed)
-tuberculin skin test
-sputum: acid-fast bacilli, Mycobacterium tuberculosis upon culture |
|
|
Term
| What are s/s of malignancy? |
|
Definition
symptoms:
-dyspnea
-cough
-hemoptysis
-fatigue
-wheezing
-chest discomfort
signs:
-ill-appearing
-weight loss
-asymmetrical breath sounds
-adventitious sounds
-stridor |
|
|
Term
| What are diagnostic tests for malignancy? |
|
Definition
-films
-CT scan
-MRI
-biopsy and histopatholgy (by fine needle aspiration, bronchoscopy, mediastinoscopy, thoracentesis) |
|
|
Term
| What causes an ACE cough? |
|
Definition
| accumulations of kinins in respiratory tract |
|
|
Term
| What are characteristics of ACE cough? |
|
Definition
-dry
-intractable
-worse at night |
|
|
Term
| What are characteristics of aspirin/NSAID cough? |
|
Definition
-tight
-dry
-wheezing
-persists after elimination of medication |
|
|
Term
|
Definition
| subjective sense of discomfort or difficulty breathing |
|
|
Term
|
Definition
| subjective sense of discomfort or difficulty breathing |
|
|
Term
| What are questions for assessing dyspnea? |
|
Definition
-setting
-situations, activities
-persistent/intermittent
-duration
-progression
-how routines affected
-associated symptoms |
|
|
Term
| What measures are used to assess dyspnea? |
|
Definition
-visual analog scale
-numerical rating |
|
|
Term
|
Definition
-abnormal collection of fluid in pleural space
-usually secondary to malignancy, HF, cirrhosis, trauma, infection |
|
|
Term
| What are s/s of pleural effusion? |
|
Definition
symptoms:
-cough
-pain
-malaise
-fever
signs:
-decreased lung sounds
-dullness
-decreased fremitus
-egophony
-whispered pectoriloquy
-mediastinum and trachea shift to opposite side (or pulled toward malignancy) |
|
|
Term
| What are diagnostic studies for pleural effusion? |
|
Definition
-chest films: increased density, blunted costophrenic angle, elevated hemidiaphragm
-plain films: mass, malignancy, infiltrates, cardiomegaly
-thoracentesis
-Gram stain
-cultures
-pH
-cytology
-chemical studies |
|
|
Term
| What are s/s for pulmonary embolism? |
|
Definition
symptoms:
-dyspnea
-pain
-cough
-hemoptysis
signs:
-tachycardia
-tachypnea
-crackles
-chest tenderness
-signs consistent with pleural effusion on affected side |
|
|
Term
| What are diagnostic studies for pulmonary embolism? |
|
Definition
-plain chest films: atelectasis, pleural effusion, infiltrates
-V/Q perfusion scanning: defect
-ABGs: respiratory alkalosis with hypoxemia and hypocapnia
-spiral CT with contrast |
|
|
Term
| What are s/s of restrictive lung dz? |
|
Definition
-family hx of intrinsic restrictive lung dz
-personal hx of exposure to toxins
signs:
-decreased excursion
-crackles |
|
|
Term
| What are causes of restrictive lung dz? |
|
Definition
-neuromuscular disorders
-kyphosis
-obesity |
|
|
Term
| What are s/s of pneumothorax? |
|
Definition
symptoms:
-sudden shortness of breath
-chest pain
symptoms:
-tachycardia
-tachypnea
-splinting
-decreased fremitus
-hyperresonance
-diminished/absent lung sounds
-trachea shift away from affected side |
|
|
Term
| What are diagnostic studies for pneumothorax? |
|
Definition
| -plain chest films: absence of lung markings, mediastinum shift |
|
|
Term
| What are s/s of insignificant obstruction in foreign body aspiration? |
|
Definition
-cough
-increasing dyspnea
-fever
-pneumonia symptoms |
|
|
Term
| What are diagnostic studies for foreign body aspiration? |
|
Definition
-plain chest films: air trapping, atelectasis, a radiolucent object
-CT scan: radiopaque object
-bronchoscopy (identify/remove) |
|
|
Term
| What are pulmonary s/s of anemia? |
|
Definition
|
|
Term
| What hx should be assessed in hemoptysis? |
|
Definition
-associated symptoms
-recent exposures to infectious dz
-TOB
-TB |
|
|
Term
| What are diagnostic tests for hemoptysis? |
|
Definition
|
|
Term
|
Definition
| pain at costosternal cartilage site |
|
|
Term
| What are s/s of costochondritis? |
|
Definition
-pain affected by breathing or chest motion, reproducible with firm pressure
-limited site of tenderness
-signs of inflammation |
|
|
Term
|
Definition
| inflammation of the pleura |
|
|
Term
| What are s/s of pleurisy? |
|
Definition
symptoms:
-acute, sharp, severe pleuritic pain with motion
-vague, consistent pain
-splints
signs:
-shallow respirations
-pleural friction rub
-pleural effusion: dullness, decreased fremitus, egophony, decreased breath sounds |
|
|
Term
| What are included in the chest inspection? |
|
Definition
-size and shape (AP:lateral diameters)
-symmetry
-color
-superficial venous patterns
-prominence of ribs |
|
|
Term
| What are included in the evaluation of respirations? |
|
Definition
|
|
Term
| What are included in the respirations inspection? |
|
Definition
-symmetry
-use of accessory muscles |
|
|
Term
| What are included in the chest palpation? |
|
Definition
-symmetry
-thoracic expansion
-sensations: crepitus, grating
-tactile fremitus |
|
|
Term
| What are included in the chest percussion? |
|
Definition
-diaphragmatic excursion
-intensity, pitch, duration, quality |
|
|
Term
| What are included in chest auscultations? |
|
Definition
-intensity, pitch, duration, quality
-unexpected breath sounds
-vocal resonance |
|
|
Term
|
Definition
-1-7: anteriorly to sternum
-8-10: superiorly to costal cartilage
-11-12: only posteriorly ("floating ribs") |
|
|
Term
| What "accessory" muscles are sometimes used to breathe in exercise or respiratory compromise? |
|
Definition
-sternocleidomastoid
-trapezius |
|
|
Term
| How many lobes are in the lungs? |
|
Definition
|
|
Term
|
Definition
-inferior tongue-like projection of left upper lobe
-counterpart to right middle lobe |
|
|
Term
| lesser horizontal fissure |
|
Definition
| -divides right lung into upper and middle lobes at the level of 5th rib in axilla and 4th rib anteriorly |
|
|
Term
| Where is the apex of the lung located? |
|
Definition
-anteriorly: 4cm above 1st rib into the base of the neck
-posteriorly: T1 |
|
|
Term
| Where are the lower borders of the lungs located? |
|
Definition
-forced expiration: T9
-deep inspiration: T12 |
|
|
Term
| The base of each lung rests on the ___?___ surface of the diaphragm. |
|
Definition
|
|
Term
| The medial surfaces of the lungs are somewhat ___?___ |
|
Definition
| -convex (cradle for the heart) |
|
|
Term
| What are the dimensions of the trachea? |
|
Definition
-10-11 cm long
-2 cm diameter |
|
|
Term
| What is the location of the trachea? |
|
Definition
-anterior to esophagus
-posterior to isthmus of thyroid |
|
|
Term
| Where does the trachea divide into left and right main bronchi? |
|
Definition
-T4, T5
-just below manubiosternal joint |
|
|
Term
| How does the right bronchus differ from the left? |
|
Definition
-wider
-shorter
-more vertical
-more susceptible to aspiration of foreign bodies |
|
|
Term
| Which lung may ride higher? Why? |
|
Definition
|
|
Term
|
Definition
-separates upper and lower lobes on each side
-5th rib at axilla, 6th rib at midclavicular line |
|
|
Term
|
Definition
-manubriosternal junction
-visible, palpable
-2nd rib articulates with sternum
-used to count ribs and intercostal spaces |
|
|
Term
| The number of each intercostal space corresponds to ___?___ |
|
Definition
| the rib immediately above it |
|
|
Term
|
Definition
-palpable depression
-visible at ventral base of neck
-superior to manubriosternal junction |
|
|
Term
|
Definition
-no more than 90 degrees
-ribs inserted at sternum at 45 degrees |
|
|
Term
|
Definition
-spinous process of C7
-seen and felt with patient's head bent forward (lower prominence is T1)
-difficult to use as a guide to counting ribs posteriorly bc spinous processes from T4 down project obliquely, overlying the rib below |
|
|
Term
| What causes the closure of the foramen ovale? |
|
Definition
| decrease in pulmonary pressure when blood flows through lungs |
|
|
Term
| What causes the closure of the ductus arteriosus? |
|
Definition
| increased oxyegen tension in the arterial blood |
|
|
Term
| What is the size and shape of the newborn's chest? |
|
Definition
-round
-AP = lateral diameter
-circumference = head circumference (until 2 yo) |
|
|
Term
| How does the newborn's chest differ from the adult's? |
|
Definition
-thin wall so more prominent bony structures
-cartilaginous
-xiphoid process more prominent and movable |
|
|
Term
| How do the chest and respirations change during pregnancy? |
|
Definition
-2 cm increase in lateral diameter
-5-7 cm increase in cirumference
-increase in subcostal angle from 68.5 to 103.5 degrees
-4 cm increase in diaphragmatic height
-increased diaphragmatic movement
-increased minute ventilation due to increased tidal volume (no change in rate) |
|
|
Term
| What causes barrel chest in older adults? |
|
Definition
-loss of muscle strength
-loss of lung resiliency
-increased dorsal curve of spine, increased AP diameter
-stiffening of chest wall |
|
|
Term
| What causes decreased vital capacity and increased residual volume in the older adult? |
|
Definition
-less elastic, more fibrous alveoli --> decreased folds --> decreased gas exchange surface
-loss of strength in muscles
-underventilation of lower lung fields
-decreased exertion tolerance |
|
|
Term
| What causes a predisposition of older adults to respiratory infection? |
|
Definition
-drier mucus membranes
-decreased ability to clear mucus |
|
|
Term
|
Definition
| increase in dyspnea in upright posture |
|
|
Term
| What indicate that chest pain does not originate in the heart? |
|
Definition
-constant achiness all day
-no radiation
-worsened by pressing on precordium
-fleeting, needle-like jab, only lasts a few seconds
-between or in shoulders |
|
|
Term
| What are some pulmonary and cardiac effects of cocaine use? |
|
Definition
-tachycardia
-HTN
-coronary arterial spasm (with infarction)
-pneumothorax |
|
|
Term
|
Definition
-AP:lateral diameter
-expected to be 0.7-0.75
-increases with age, but near 1.0 a chronic condition is suspected |
|
|
Term
|
Definition
| posterior deviation of spine |
|
|
Term
|
Definition
| lateral deviation of spine |
|
|
Term
|
Definition
| indentation of lower sternum above xiphoid process |
|
|
Term
|
Definition
-prominent sternal protrusion
-pigeon chest |
|
|
Term
| What is the expected ratio of respirations to heartbeats? |
|
Definition
|
|
Term
| Cheyne-Stokes respirations/periodic breathing |
|
Definition
-varying periods of increasing depth interspersed with apnea
-in infant, older adult while sleeping
-in cerebral brain damage, drug-associated respiratory compromise |
|
|
Term
|
Definition
|
|
Term
|
Definition
-irregularly interspersed periods of apnea in disorganized sequence of breaths
-intracranial pressure, drug poisoning associated respiratory compromise, medullary brain damage |
|
|
Term
|
Definition
| significant disorganization with irregular and varying depths of respiration |
|
|
Term
| What are causes of chest asymmetry? |
|
Definition
-collapsed lung
-limitation of expansion by extrapleural air, fluid, mass |
|
|
Term
| What are causes of unilateral or bilateral bulging? |
|
Definition
-respiratory obstruction
-bulging on expiration: outflow obstruction, compression (tumor, enlarged heart, aneurysm) |
|
|
Term
| What causes intercostal retractions? |
|
Definition
-obstruction to inspiration
-increasing negative pressure causes musculature to pull back |
|
|
Term
| What causes paradoxic breathing? |
|
Definition
-negative intrathorcic pressure transmitted to abdomen
-weakened diaphragm, obstructive airway dz, upper airway obstruction during sleep |
|
|
Term
| What causes unilateral retraction? |
|
Definition
| -foreign body in bronchus (usually right) |
|
|
Term
| What causes retraction of lower chest? |
|
Definition
|
|
Term
| What is crepitus? What does it indicate? |
|
Definition
-crackly, crinkly sensation that can be palpated and heard
-air in subcutaneous tissue
-rupture in respiratory system, infection with gas-producing organism |
|
|
Term
| Where is fremitus best felt? |
|
Definition
| parasternally at 2nd intercostal space (level of bronchi bifurcation) |
|
|
Term
| What cause decreased fremitus? |
|
Definition
-excess air in lungs
-emphysema
-pleural thickening or effusion
-pulmonary edema
-bronchial obstruction |
|
|
Term
| What cause increased fremitus? |
|
Definition
-lung consolidation
-heavy bronchial secretions
-compressed lung
-tumor |
|
|
Term
| What cause gentle, tremulous fremitus? |
|
Definition
-some lung consolidations
-some inflammatory and infectious processes |
|
|
Term
| How is the trachea palpated? |
|
Definition
-index finger in suprasternal notch, move side to side along upper edge of clavicle
-both thumbs |
|
|
Term
| What cause the trachea to be pulled toward affected side? |
|
Definition
volume loss:
-atelectasis
-fibrosis
-tumor
-adenopathy |
|
|
Term
| What cause the trachea to be deviated away from affected side? |
|
Definition
-thyroid enlargement
-pleural effusion |
|
|
Term
| How does pneumothorax affect trachea placement? |
|
Definition
-tension pneumothorax: deviated away from affected side
-collapsed lung: deviated to affected side |
|
|
Term
| What causes the trachea to be pushed posteriorly? |
|
Definition
| -anterior mediastinal tumors |
|
|
Term
| What causes the trachea to be pushed anteriorly? |
|
Definition
|
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Term
|
Definition
| a palpable pull of the trachea out of midline with respiration |
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Term
| At what intervals should lung fields be percussed? |
|
Definition
| 4-5 cm over intercostal spaces |
|
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Term
| What are indicated by hyperresonance on percussion? |
|
Definition
hyperinflation:
-emphysema
-pneumothorax
-asthma |
|
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Term
| What are indicated by dullness, flatness on percussion? |
|
Definition
-pneumonia
-atelectasis
-pleural effusion
-pneumothorax
-asthma |
|
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Term
| What is indicated by tympany on percussion? |
|
Definition
|
|
Term
| What are 2 methods of percussion? |
|
Definition
-direct: ulnar aspect of fist
-indirect: middle fingers |
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Term
| What decrease diaphragmatic descent? |
|
Definition
pulmonary:
-emphysema
abdominal:
-ascites
-tumor
superficial pain:
-fractured rib |
|
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Term
| What is the expected diaphragmatic excursion? |
|
Definition
|
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Term
| What is a way to prevent fatigue in older patients during an exam? |
|
Definition
| -examine lung bases first, where most pathologic conditions occur |
|
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Term
| Which part of the stethoscope is best for auscultating lungs? Why? |
|
Definition
-diaphragm
-transmits high-pitched sounds better, provides broader area of sound |
|
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Term
| What are patient positions for ausculation of different chest regions? |
|
Definition
-back: head bent forward, arms folded across chest
-lateral: erect, arms overhead
-anterior: erect, shoulders back |
|
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Term
| Where should lung sounds in right middle lobe and left lingula be auscultated? |
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Definition
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Term
|
Definition
-breath sounds like air being blown across the mouth of a bottle
-large, stiff walled pulmonary cavity
-tension pneumothorax with bronchopleural fistula |
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Term
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Definition
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Term
| Crackles can be cleared by a cough. T/F |
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Definition
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Term
|
Definition
-high pitched
-discrete
-discontinuous
-end of inspiration |
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Term
|
Definition
-lower
-moist
-midstage of inspiration |
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Term
|
Definition
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Term
|
Definition
-loud
-low
-coarse
- ~ snore
-continuous during inspiration or expiration
-may be cleared by coughing, indicating mucus accumulation in trachea or large bronchi |
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Term
|
Definition
-musical
-squeak
-continuous during inspiration or expiration
-louder during expiration |
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Term
|
Definition
-dry
-rubbing, grating
-during inspiration or expiration
-loudest over lower lateral anterior surface |
|
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Term
| Where are dry, crisp crackles more likely to occur? |
|
Definition
|
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Term
|
Definition
-thick secretions
-muscular spasm
-new growth
-external pressure |
|
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Term
| What characteristics of wheezes indicate a worse obstruction? |
|
Definition
-longer duration
-higher pitch |
|
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Term
| What cause bilateral wheezes? |
|
Definition
-asthma bronchospasm
-acute or chronic bronchitis |
|
|
Term
| What cause unilateral wheezes? |
|
Definition
|
|
Term
| What kind of wheezes do tumors create? |
|
Definition
-consistent
-single pitch (at site of compression) |
|
|
Term
| Where does a friction rub have no significance? |
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Definition
|
|
Term
| mediastinal crunch/Hamman sign |
|
Definition
-loud crackles, clicks, gurgles
-synchronous with heartbeat, not respirations
-more pronounced with end of expiration
-easier to hear when leaning to/lying on left
-indicates mediastinal emphysema |
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Term
| Where is vocal resonance best auscultated? |
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Definition
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Term
| The factors that influence tactile fremitus similarly influence ___?___ |
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Definition
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Term
| What conditions can cause a reflexive cough response? |
|
Definition
-foreign body
-infectious agent
-mass compressing respiratory tree |
|
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Term
| What does an infrequent cough indicate? |
|
Definition
-allergen
-environmental insult |
|
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Term
| What is the regularity and quality of a pertussis cough? |
|
Definition
-regular, paroxysmal
-inspiratory whoop at end of a paroxysm |
|
|
Term
| What does a brassy quality cough indicate? |
|
Definition
| compression of respiratory tree |
|
|
Term
| What is the quality of a croup cough? |
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Definition
|
|
Term
| Where does snoring and gurgling originate? |
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Definition
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|
Term
| Where does stridor originate? |
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Definition
|
|
Term
| What does acute sputum production indicate? Chronic? |
|
Definition
-infection
-significant anatomic change (tumor, cavitation, bronchiectasis) |
|
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Term
| What does yellow, green, rust, clear or transparent, purulent, blood-streaked, mucoid, viscid sputum indicate? |
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Definition
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Term
| What does mucoid, viscid, blood-streaked (uncommon) sputum indicate? |
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Definition
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Term
| What does sputum that is abundant in the early morning with slight, intermittent blood streaking and occasional large amounts of blood indicate? |
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Definition
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Term
| What does sputum with slight, persistent blood streaking indicate? |
|
Definition
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|
Term
| What does blood clotted sputum with large amounts of blood indicate? |
|
Definition
|
|
Term
| What does sputum with occasional large amounts of blood indicate? |
|
Definition
|
|
Term
| What is the chest circumference of a healthy full term infant? |
|
Definition
| -30-36 cm circumference (2-3 cm smaller than head circumference) |
|
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Term
| What conditions can affect the chest circumference of a newborn? |
|
Definition
-prematurity: larger difference between head and chest circumferences
-IUGR: relatively smaller chest compared to head
-poorly controlled DM in mother: relatively larger chest circumferece |
|
|
Term
| Babies delivered by cesarean have a ___?___ respiratory rate |
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Definition
|
|
Term
| periodic breathing in the infant |
|
Definition
-sequence of relatively vigorous respirations followed by apnea 10-15 sec
-concerning if prolonged or causing central cyanosis
-persistence relative to gestational age (should wane a few hours after birth in full term infant) |
|
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Term
| ___?___ is rare and problematic in the newborn; ___?___ is frequent and expected. |
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Definition
|
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Term
| What might be suggested by frequent hiccupping? |
|
Definition
-sz
-drug withdrawal
-encephalopathy |
|
|
Term
| Paradoxic breathing is common during infant sleep. T/F |
|
Definition
|
|
Term
| What might be palpated on an infant's fractured clavicle following a difficult forceps delivery? |
|
Definition
|
|
Term
| What are expected auscultated sounds in a newborn due to fetal fluid that hasn't been cleared yet? |
|
Definition
|
|
Term
| What might persistent GI gurgling in the newborn chest indicate? |
|
Definition
|
|
Term
| When is stridor especially concerning? |
|
Definition
-inspiration 3-4x longer than expiration
-accompanied by cough, hoarseness, retraction
-retraction at supraclavicular notch and contraction of sternocleidomastoid muscles |
|
|
Term
| What conditions might cause stridor in the infant? |
|
Definition
-floppy epiglottis
-congenital defect
-croup
-edematous response to infection, allergen, foreign body
-compression by tumor causing narrow tracheal lumen |
|
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Term
|
Definition
-infant trying to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
-concerning if persistent |
|
|
Term
| At what age do children use thoracic (intercostal) musculature for respiration? |
|
Definition
|
|
Term
| There are significant gender differences in respiratory rates. T/F |
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| At what age is a persistent round chest of concern? Why? |
|
Definition
-2 yo
-chronic obstructive problem, e.g. CF |
|
|
Term
| How can a chest assessment be performed on a crying child? |
|
Definition
-evaluate vocal resonance and tactile fremitus during sob
-auscultate deep breath following sob
-auscultate heart sounds during pause |
|
|
Term
| What are strategies to elicit expiratory sounds in a young child? |
|
Definition
-"blow out" flashlight
-blow away a bit of tissue
-after running up and down hallway |
|
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Term
| A small loss of resonance in a young child is of no concern. T/F |
|
Definition
| false- give as much importance as frank dullness in an adolescent or adult |
|
|
Term
| How does the child's thin chest wall affect breath sounds? |
|
Definition
-louder
-harsher
-more bronchial; bronchovesicular sounds throughout |
|
|
Term
| Acute bacterial pneumonia may be present even in the absence of crackles. T/F |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| purulent exudative fluid collected in the pleural space |
|
|
Term
| What are causes of lung abscess? |
|
Definition
-aspiration of food
-aspiration of infected material from upper airway
-aspiration of dental infection |
|
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Term
|
Definition
| acute or chronic condition involving right sided heart failure |
|
|
Term
| What objective data are found in cor pulmonale? |
|
Definition
-right ventricular heave
-elevated jugular venous pulsation
-lower extremity edema |
|
|
Term
| What are the pathophysiology and findings associated with respiratory distress syndrome? |
|
Definition
-difficulty breathing in preterm infant
-surfactant deficiency
-decreasing gestational age, maternal DM, acute asphyxia
-tachypnea, grunting, cyanosis |
|
|
Term
| What is the occurrence of diaphragmatic hernia? |
|
Definition
|
|
Term
| On which side does diaphragmatic hernia usually occur? Why? |
|
Definition
-left in 90%
-liver not in the way |
|
|
Term
| What are subjective and objective findings in diaphragmatic hernia? |
|
Definition
-respiratory distress
-bowel sounds in chest
-flat or scaphoid abdomen
-heart displaced to the right |
|
|
Term
| What are subjective and objective findings in CF? |
|
Definition
-cough with sputum < 5 yo
-distinct salt taste of sweat
-malabsorption, poor weight gain, intestinal obstruction
-bronchiectasis
-clubbing
-pulmonary HTN
-cor pulmonale |
|
|
Term
| What has greatly reduced the incidence of epiglottitis? |
|
Definition
|
|
Term
| In what ages does epiglottitis most commonly occur? |
|
Definition
|
|
Term
| What is the pathophysiology of croup? |
|
Definition
| -infection with viral agent (often parainfluenzas) causes subglottic inflammation |
|
|
Term
| What is the pathophysiology of tracheomalacia? |
|
Definition
-floppiness of trachea or airway
-benign and self-limited |
|
|
Term
| What are objective findings of tracheomalacia? |
|
Definition
|
|
Term
| What is the pathophysiology of bronchiolitis? |
|
Definition
-bronchiolar (small airway) inflammation
-causes hyperinflation of lungs
-most common in < 6 mos
-usual cause is RSV |
|
|
Term
| What examination technique is used to assess tracheal tug? |
|
Definition
|
|
Term
| What examination technique is used to assess diaphragmatic excursion? |
|
Definition
|
|
Term
| Are bowel sounds in the newborn chest considered a normal finding? |
|
Definition
| no- indicate diaphragmatic hernia |
|
|
Term
| What does diaphragmatic excursion of 4 cm on one side and 8 cm on the other indicate? |
|
Definition
|
|
Term
| What technique is used to inspect nail beds for clubbing? |
|
Definition
-Schamroth Technique
-place same fingernails of opposite hands against each other and see if the "diamond window" is present or obliterated |
|
|
Term
| An asthmatic patient's respiratory past medical history should include a skin test for fungus. T/F |
|
Definition
|
|
Term
| ___?___ are prolonged in asthma. |
|
Definition
|
|
Term
| Mucus plugs in bronchioles and cause atelectasis. T/F |
|
Definition
|
|
Term
| Where do embolized clots from lower extremities travel to? |
|
Definition
| inferior vena cava, right heart, then pulmonary artery |
|
|
Term
| What is the initial respiratory response to a pulmonary embolism? |
|
Definition
| hyperventilate to bring oxygen to the rest of the pulmonary tree |
|
|
Term
| What is 1st line therapy for a PE? 2nd? More agressive? |
|
Definition
-supplemental oxygen
-IV anticoagulant, followed by constant infusion to stabilize clot
-IV thrombolytics |
|
|
Term
|
Definition
| doesn't create significant pressure in the thoracic cavity |
|
|
Term
| What is the difference in location between stridor and wheeze? |
|
Definition
-stridor: more central airways
-wheeze: more peripheral |
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